The PRESIDING OFFICER. Under the previous order, the Senate will
proceed to executive session to resume consideration of the Rao
nomination, which the clerk will report.

The bill clerk read the nomination of Neomi Rao, of the District of
Columbia, to be Administrator of the Office of Information and
Regulatory Affairs, Office of Management and Budget.

The PRESIDING OFFICER. The Senator from Florida.
(The remarks of Mr. NELSON pertaining to the introduction of S. 1521
are printed in today's Record under “Statements on Introduced Bills
and Joint Resolutions.”)

Mr. CORNYN. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.

The PRESIDING OFFICER (Mrs. Ernst). Without objection, it is so
ordered.
Healthcare Legislation

Mr. CORNYN. Madam President, I know we are all glad to be back in
Washington, DC, at work after a few days back home, and I know many of
us are eager to continue our work to rescue the American people from
the failures of the Affordable Care Act, otherwise known as ObamaCare.

The failures of ObamaCare are well documented, and while they don't
necessarily apply to everyone, particular individuals and small
businesses in the so-called individual market have seen a meltdown of
the insurance exchanges. The Presiding Officer in her home State of
Iowa, I know, has had insurance companies pulling out to the point
where people can't even find an insurance carrier who will sell a
policy that qualifies under the Affordable Care Act. That is because
the Affordable Care Act was, unfortunately, a partisan exercise and a
Big Government experiment that has failed.

All you have to do is look at the promises that were made at the time
that ObamaCare was being sold back in 2009 and 2010. The President
himself said that if you like your doctor, you can keep your doctor.
Well, that proved to be not true. He said that if you liked your
policy, you can keep your policy. Well, that proved not to be true as
well because people saw their policies canceled because they couldn't
qualify under the new requirements of the Affordable Care Act.

Perhaps the thing that stung the most was the fact that the President
said back in 2009 and 2010 that an average family of four would see a
reduction in their health insurance premiums by an average of $2,500.
Well, what we have seen since 2013 is a 105-percent increase in
insurance premiums under the Affordable Care Act, and so instead of
seeing a cut in their out-of-pocket costs of $2,500, what people have
experienced--families of four--is an insurance premium increase of
$3,000. Now, some people may be able to absorb that cost, but most
people I know cannot. What it has meant is, they have had to
reprioritize their spending so they have less to spend on other things
in their life.

We do know, based on the promises made at the time the Affordable
Care Act was being sold to the American people, that it has been a
failed experiment. So the question is, What are we going to do about
it? What are we going to tell the folks in Iowa who can't find an
insurance policy or an insurance company who is willing to sell them an
insurance policy on the individual market? What are we going to tell
people in Texas who have seen their premiums go up by 105 percent since
2013 and have been priced out of the market or who found that the only
policy they can afford is one with deductibles that are so high that
basically they are denied the benefit of their insurance at all? What
are we going to do about it?

A number of my colleagues have noted that even if Hillary Clinton
were elected President of the United States, we would still have to be
revisiting the failures of the Affordable Care Act because the failures
are all too obvious and public and can't be denied, but despite that,
and acknowledging many of ObamaCare's failings, many of our friends
across the aisle--in fact, all of them so far in the Senate--have made
clear they want nothing to do with providing any help or any aid to the
people who are being hurt by the failures of ObamaCare. They don't want
to lift a finger to help the people who can't find insurance, who can't
afford it, and the policies they are forced to buy limit them in a way
that they simply have decided to opt out.

So instead of working together with us--you would think they would do
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that. It would just be a logical thing to do because their constituents
are the ones who are being hurt, in many instances. Instead, they have
fought us tooth and toenail to preserve the broken status quo in
healthcare that has failed so many people across the country, and they
have made dubious claims about our efforts to address the problem to
the best of our ability.

It reminds me of the old saying: Don't let the facts get in the way
of a good story. Our friends across the aisle have simply washed their
hands of any responsibility, even though they are the ones who passed
the Affordable Care Act and created this failed experiment and put so
many people in distress. Now they are in the process of attacking those
of us who are trying to help people who are hurting, rather than
lending a helping hand and working together with us in a bipartisan
way.

Let me talk just a minute about Medicaid because this is one of the
big attacks that is being made by our Democratic colleagues on our
efforts to try to salvage healthcare for people who are hurt by the
failures of the Affordable Care Act. Much of the conversation has
revolved around Medicaid and rightly so.

In my home State, 4.7 million folks currently rely on Medicaid. It is
an important safety net program for people who are in low-income
status--so for poorer folks. For those Americans, I want to make sure
they understand, notwithstanding all the scare tactics, Medicaid is not
going away.

Now, one of the common refrains is that Medicaid spending is slashed
in the Better Care Act, but the nonpartisan Congressional Budget Office
estimates that Medicaid spending will grow by $74 billion over 10
years. So when they have talked about it being cut, it actually grows
by $71 billion over 4 years.

I would also point out there are some who think the current rate of
spending on Medicaid can go forward unabated without any changes, and
that is simply not true. We know that according to the Congressional
Research Service, Medicaid spending across the country totaled $494
billion in 2014. I guess that was the last year for which full
statistics were available--$494 billion. If we do nothing to check the
rate of growth of Medicaid spending, in 2023, it will be $835 billion.
So you go from $494 billion to $835 billion. We simply cannot keep up
with that pace of spending.

Many of us--the Presiding Officer being one of them--are concerned
about cuts in our military, which is the one thing the Federal
Government has to do because nobody else can do it. Right now, we have
seen, during the last administration, cuts of about 20 percent in our
defense spending.

Well, when you have runaway spending in entitlement programs like
Medicaid, where nobody is placed on a budget and forced to spend wisely
and efficiently, essentially by forcing the Federal Government to spend
$835 billion for Medicaid spending alone, that is going to crowd out a
lot of other meritorious and important spending, including for defense
spending as well.

So we need to make sure Medicaid is there but that Medicaid is put on
a responsible budget that grows year after year. In fact, during the
life of this particular bill, over the next 10 years, it will go up $71
billion.

Here is another thing. Our friends across the aisle act like Medicaid
is the very best program to come down the pike. Well, it is not, and
there are a number of reasons for that. One is that Medicaid recipients
don't always get the quality of care or the access to care we would
hope for. That is because the States, which set the rate of
reimbursement of doctors for Medicare beneficiaries, set it so low that
it is roughly half the amount that is reimbursed based on private
insurance. That is the reason why, in 2000, 67 percent of Texas
physicians accepted new Medicaid patients. Today, it is 31 percent. So
if you are on Medicaid, there is a two-thirds chance you will not be
able to find a doctor to see you as a Medicaid beneficiary.

What we have done, instead, in the Better Care Act--particularly for
the single adult population between 100 percent and 135 percent of the
Federal poverty level--is, we said we will give you a refundable tax
credit you can use to buy private insurance. Private insurance is
highly preferable to Medicaid because, for one thing, it reimburses
physicians at a higher rate and gives people greater access to
physicians, hospitals, and greater quality of care. In my State alone,
in the State of Texas, according to the Kaiser Family Foundation, as
many as 600,000 new low-income Texans will benefit from the provisions
of the Better Care Act. It will help qualify them for a tax credit not
available to them under ObamaCare.

Simply throwing money at Medicaid will not help people at all. We
need to reform Medicaid and make it more efficient. Frankly, one of the
things I did back when we were debating the Affordable Care Act in the
Senate Finance Committee, I actually filed an amendment that said
Members of Congress would go on Medicaid. Well, it failed, but the
point I was trying to make is that if Members of Congress were on
Medicaid, we would fix Medicaid. Right now, it is substandard
healthcare for the reasons I mentioned. Two-thirds of the doctors in my
State alone refuse to see a new Medicaid patient because it pays them
so far under the standard of private insurance or even Medicare.

By providing low-income Americans access to private insurance instead
of Medicaid, we can assist those who were previously left out of the
healthcare market and will now be able to purchase a plan of their
choice perhaps for the first time. Unless we act, we are going to
continue to see skyrocketing premiums and deductibles and lost
coverage.

The American people were told time and time again that under
ObamaCare costs would go down and they would be able to keep their
doctor, which has proven not to be the case.

I mentioned before on the floor of the Senate that in my previous
life as attorney general of Texas, we had something called the Consumer
Protection Division, and if some business made false claims about a
service or product to the American people when it came to their
healthcare, the U.S. Government would take them to court and we would
win because it is simply a deceptive trade practice in that context. It
is deception. It is deceit. Unfortunately, the American people were
bamboozled by promises that were not kept.

We also know that about $1 trillion in ObamaCare taxes--new taxes
that were imposed to pay for ObamaCare--have ultimately been saddled on
American families with higher costs for healthcare. When ObamaCare was
passed and all these new taxes were passed, my friends across the aisle
acted as though they would simply be absorbed by somebody, but we all
know that simple economics means that ultimately the consumers are the
people who actually pay the tab. They are the ones who end up paying
the taxes.

Some of our colleagues on the other side recognized the destructive
nature of the Affordable Care Act tax scheme. For example, five
Democratic Senators, including my colleagues from Minnesota, voted to
repeal the medical device tax just 2 years ago. The medical device tax
was a draconian form of taxation. It wasn't based on income--in other
words, where you could deduct your expenses and just pay taxes on your
net income--it was a gross receipts tax. In other words, it said in
effect that everything you have earned before you deduct your costs of
doing business is going to be taxed at a given rate, and that was true
of the medical device tax.

Perversely, a tax on medical devices meant not only did the jobs to
produce those medical devices move offshore, in the case of one Texas-
based company, they moved their business essentially to Costa Rica in
order to avoid the taxes because they simply couldn't afford to pay
them and stay in business and keep the jobs they had.

It was also a tax on innovation, and that is the reason we saw a
bipartisan response to repeal the medical device tax just 2 years ago,
because this tax has chased away jobs and innovation in the medical
sector and saddled consumers with higher costs.

By repealing those taxes in the Better Care Act, we not only will
lower the bill at the pharmacy or the doctor's office, but we encourage
competition, and that is common sense and ultimately benefits
consumers.

Our plan also protects consumers from government mandates requiring
[[Page S3878]]
them to buy insurance that they don't want and can't afford. This way,
families can choose what works best for them, free from the penalties
by the government. Some individuals may choose to go with no plan at
all.

The dirty little secret about the Affordable Care Act is that it
can't work without a government mandate that you buy government-
approved health insurance or else you pay a penalty. I can't think of
any other instance where the government says “You do what we say, or
we are going to punish you and penalize you,” as the Affordable Care
Act does.

Even with the individual mandate and this threat of a penalty, we
know that about 28 million Americans are currently not covered by
insurance. Many of them are covered by so-called hardship exceptions.
About 6.5 million of them just pay the penalty because it is cheaper to
pay the penalty than it is to buy the insurance because the prices are
so high.

When some of the critics say that without this economic gun to the
head of a penalty, people will choose not to buy insurance for
themselves, that is a choice they will make as Americans. We believe in
freedom of choice, and when the marketplace provides a product that
they believe adds value at a price they can afford, that is when
consumers buy a product or a service. But they shouldn't have to do it
because the government forces them to do so and penalizes them if they
don't. The Better Care Act gives people the ability, free from a
government mandate, to choose not to buy something they don't want. The
Washington-forced mandates are gone.

The nonpartisan budget office has estimated that under our plan,
average premiums will decrease by nearly one-third in 3 years.

These are some of the important facts we need to be debating, not the
misrepresentations that unfortunately seem to fill the void.

I have shared multiple stories from my constituents back home in the
last few weeks on the floor, and I plan to keep doing that as we
continue our work on this legislation. The stories that I and my
colleagues have heard are what have inspired me and motivated me from
the beginning of this entire process. In fact, it is our job to
represent our constituents. I would encourage all of our colleagues to
listen to their own States and to share the trials of their
constituents as well because the status quo is simply unacceptable. The
Democratic leader has said as much. He said that if we set aside the
Better Care Act and are actually interested in helping “fix”
ObamaCare, they are willing to do that. But do you know what that is?
Basically, what that represents is a huge, multimillion-dollar bailout
of insurance companies without any other reform. That is what our
Democratic colleagues are supporting by their failure to engage with us
in making sure there are reforms in addition to the other things that
we do.

The other alternative plan--you might ask: Well, if Obamacare didn't
work as was advertised--which it clearly hasn't--and something needs to
be done, what does that something look like?

In the case of our friend the Senator from Vermont, Mr. Bernie
Sanders, he said: I have an idea. Let's just make the Federal
Government provide insurance coverage for everybody, single-payer.

Well, that is simply a solution we can't afford when we look at the
tradeoffs. It would essentially supplant all the private insurance that
people get from their employers and require incredible increases in
taxes in order to do that across the board. So I don't think that is an
alternative our friends across the aisle want to support. They love the
mandate, they love penalizing free American citizens when they don't
purchase a product the government mandates, but they are not going to
defend that. They are not going to defend that. They certainly won't
advocate, at least openly here on the floor, for a single-payer system.

We saw one committee of the legislature in California recently vote
out a single-payer system. This was just one committee, I think, in one
house. The estimated cost of a single-payer system in California alone
was double the annual budget of the entire State. You can imagine what
the numbers would be here at the national level.

Like any piece of legislation, our draft bill can be strengthened,
and we would invite anyone in good faith who is interested in
strengthening the bill to work with us to do so. We are going to
continue to talk and listen and exchange ideas on how we can continue
to make improvements, but in the end, the choice is clear: You either
ultimately support ObamaCare and the status quo, or you are willing to
try to work with us to produce something better that provides more
affordable healthcare from the doctor and healthcare provider of your
choice. That is simply the choice people are going to have. A “no”
vote against the alternative is simply a vote for the status quo for
ObamaCare, and we know where that is going to lead--it is going to lead
with a big, multibillion-dollar bailout of insurance companies without
any reform. That is what our Democratic colleagues are hoping for if we
are unsuccessful. But we think there is a better way to approach this,
one that brings down cost and maintains choices and the freedom of
choice for the individual consumer.

We will continue to plow ahead with or without their help because we
think it is our duty to do so, and we have confidence that, working
together, we can come up with a better care plan that suits the needs
of Americans when it comes to their healthcare.

I yield the floor.

I suggest the absence of a quorum.

The PRESIDING OFFICER. The clerk will call the roll.

The bill clerk proceeded to call the roll.

Ms. WARREN. Madam President, I ask unanimous consent that the order
for the quorum call be rescinded.

The PRESIDING OFFICER. Without objection, it is so ordered.

Ms. WARREN. Madam President, from day one, this administration,
President Trump, and congressional Republicans have attacked rules that
protect working families.

Just 1 hour after taking the oath of office, President Trump
indefinitely suspended a plan that made it easier for working families
to be able to afford a mortgage. Ten days later, he issued an Executive
order that requires agencies to identify and eliminate two rules for
every one new rule they issue, and that was just the beginning.
Congressional Republicans spent the first few months of the year
eliminating rules that protected workers, students, and families. They
killed a rule that required companies in dangerous industries to track
when their employees were injured. They even killed a rule that helped
keep guns out of the hands of the mentally ill.

These rules all had one thing in common--they all made sure the
public health, safety, and security of Americans came ahead of
industry's bottom line.

Oh, and there was a second thing in common for these rules: Industry
hated them. With President Trump in office and Republicans in the
majority in Congress, those industries were ready to cash in, and they
had their wish list ready.

Although the attack on public-centered rules has increased in
intensity during this administration, I just want to say it is not new.
Powerful companies have long understood that the fight in Congress is
just the first of many battles. If Big Business can't weaken or kill
bills they don't like in Congress, they turn their attention to the
agencies tasked with implementing those laws, working to tilt the
rulemaking process in their favor, and they don't waste any time
getting started.

Long before rules are even announced, giant corporations intensely
lobby agencies--setting up meeting after meeting--to make sure the
agencies will prioritize corporate interests. As rules wind their way
through the rulemaking process, the lobbying intensifies. Companies
bury agencies in mountains of expensive, industry-funded comments. They
cite sham research and bought-and-paid-for experts. If, at the end of
that long, arduous process, a strong, public-centered rule is published
anyway, those companies sue, looking to busy judges who are unfamiliar
with the issues to overturn the decision of expert agencies.

There are no two ways about it. The rulemaking process is broken.
There are far too many opportunities for giant corporations to
influence the
[[Page S3879]]
rulemaking process, and there are far too few opportunities for
meaningful public participation, but Republicans don't want to fix this
problem--no way. They want to make the rulemaking process work even
better for their corporate buddies and work even harder against
American families.

And, boy, did they pick the right person to lead the charge.
President Trump nominated Neomi Rao--a law school professor who
advocates for weakening and handcuffing agencies--to run the Office of
Information and Regulatory Affairs known as OIRA.

OIRA is a small, little-known but intensely powerful office that
renews economically significant Federal rules. Before the Department of
Labor can issue a rule on workplace safety, for example, or the
Environmental Protection Agency can issue a rule restricting water
pollution or the Department of Education can issue a rule protecting
students from shady, for-profit colleges, that rule must be submitted
to OIRA to sign off. If OIRA doesn't like the rule, it can change the
rule or hold it up for months at a time. When a rule finally makes it
out of the OIRA ringer, chances are that any changes will be slanted in
favor of corporate interests.

Professor Rao's view of agencies makes her the wrong person to lead
this powerful agency. She believes judges should pay less attention to
the conclusions of experts at Federal agencies, and Professor Rao is
especially critical of the Consumer Financial Protection Bureau--the
CFPB. This is the agency that has forced the biggest corporations and
banks in this country to return more than $12 billion directly to
Americans they have cheated and held big banks like Wells Fargo
accountable when they have ripped off customers.

Professor Rao says the CFPB's problem is its independence--seriously.
Maybe Professor Rao thinks that little agency just doesn't kowtow
enough to the big banks. If Professor Rao had her way, independent
agencies like the CFPB would be handcuffed by OIRA, the agency she
wants to run. It is no surprise that the Wall Street giants that have
been trying to take down the CFPB for years love Professor Rao's views.

If confirmed, Professor Rao will be perfectly positioned to put her
theories into practice. She will head the Trump administration's
efforts to toss out the rules big businesses don't like. She will
determine whether rules go through the slanted OIRA process. She will
have a chance to gut strong rules that help working families.

The rulemaking process is broken, and there is a lot Congress should
be doing to fix it, to try to make it work better for people all across
this country--for workers and for families and for people who get
cheated, but the Trump administration wants to go in the opposite
direction.

Any Senator who believes corporations need more say in the rulemaking
process should vote for Neomi Rao, but anyone who thinks we are
supposed to be here to work for the American people will vote to reject
her nomination.

I yield the floor.

I suggest the absence of a quorum.

The PRESIDING OFFICER. The clerk will call the roll.

The senior assistant legislative clerk proceeded to call the roll.

Mr. STRANGE. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.

The PRESIDING OFFICER (Mr. Moran). Without objection, it is so
ordered.

Under the previous order, all postcloture time is expired.

The question is, Will the Senate advise and consent to the Rao
nomination?

Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Alaska (Ms. Murkowski), the Senator from Ohio (Mr.
Portman), the Senator from Alaska (Mr. Sullivan), and the Senator from
North Carolina (Mr. Tillis).

Further, if present and voting, the Senator from North Carolina (Mr.
Tillis) would have voted “yea” and the Senator from Alaska (Ms.
Murkowski) would have voted “yea.”

Mr. DURBIN. I announce that the Senator from New Mexico (Mr. Udall)
is necessarily absent.

The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?

Mr. BARRASSO. Mr. President, I ask unanimous consent that with
respect to the Rao nomination, the motion to reconsider be considered
made and laid upon the table and the President be immediately notified
of the Senate's action.

The PRESIDING OFFICER. Without objection, it is so ordered.
____________________